Tag Archives: attitudes to gay clients

I wanted to say how incredibly moved I am by the level of support I’ve received since announcing my resignation from BACP yesterday.I had no idea that my social media influence was quite so effective and I’ve been overwhelmed by the positive comments of gratitude for taking a principled stand and raising awareness of their failure to address the mental health needs of our community.

I have also been deeply saddened by seeing the high level of disaffection with BACP – the largest counselling and psychotherapy body in the UK.

“..Removing yourself from such an organisation and doing so publicly gives a voice to all those lgbtq people who have suffered from BACP’s heel dragging and it also empowers the new Society by having you give authority and credence to its stand on issues of sexuality, orientation, and expression.”

I’ve sat by for almost 35long years hoping BACP would do the right thing and address the issues of improving the quality of mental health provision for LGBT people.

It’s not as if there are no gay people working in the highest echelons of BACP. But it’s largely cis white gay male privilege reinforcing the status quo from within. I recall in my early days of attending BACP annual conferences (when they had such things) that I’d be largely avoided by ‘discretely’ gay/bi senior officials – fear of guilt by association.But it gave me some sense that BACP might be alright and looking out for us.

Sadly this is not the case.They’ve done very little over these three decades to raise the standards of counsellor training to help therapists feel more comfortable discussing sex and relationship issues let alone anything less mainstream like Gender, Sexual and Relationship Diversities (GSRD).I’ve written about this before: Not in Front of the Students in 2007. Nothing’s changed as Meg-John Barker and I reported last year in an article on the UKCP Journal The Psychotherapist

Meanwhile I’ve ploughed my own furrow and made way for a new generation of GSRD therapists and had the privilege of training and working alongside many of them. Developing courses to fill the gap left by the heteronormative mainstream has failed to address.

As Audre Lorde said:
“For the master’s tools will never dismantle the master’s house. They may allow us to temporarily beat him at his own game, but they will never enable us to bring about genuine change. Racism and homophobia are real conditions of all our lives in this place and time. I urge each one of us here to reach down into that deep place of knowledge inside herself and touch that terror and loathing of any difference that lives here. See whose face it wears. Then the personal as the political can begin to illuminate all our choices.”

It’s fascinating that BACP has never sought to create a division around gender and sexual diversity issues.The old PSRF (Personal, Sexual, Relationship and Family) division got rebranded ‘Private Practice’ and there was, for a few years a RACE division but that limped along poorly supported and so as Lorde predicted, the queers and those of colour created their own spaces for support, training and development.The Black and Asian Therapists Network (BAATN) is a thriving active body which meets regularly in London (co-incidentally in the same building as we run our training workshops).

Over the years, largely because of the lack of attention to diversity, I have programmed many large conferences addressing gender, sexuality and relationship diversity issues.Personally taking the risk of financial loss if they’re not well enough attended (and one of these cost me £3k of my savings).I am enormously committed to improving the quality of therapy available and the training of therapists has been a major focus of my career. Pink Therapy receives no grants or external funding.It’s entirely funded from training course fees and directory membership fees. We’ve also followed BAATN’s lead and developed a mentoring scheme because of the endemic homophobia, biphobia and transphobia many counsellors feel in their training courses.

So it feels a kick in the teeth when I hear from people whom I’ve always respected that they feel there is a lack of evidence that Conversion Therapy is being practiced on trans and gender variant people and on asexuals.They may not know of it happening, they may not have seen the research, but that DOES NOT mean there is no evidence! (yesterday I cited several studies). Those of us closely connected to the Trans and Asexual communities are hearing all the time about how crappy therapists have been, how inappropriately they’ve treated them. It’s unfortunate that BACP are so out of touch and uninterested in learning from our communities.

Conversion therapy in the UK is also on a pretty small scale and I’m not sure there has been much ‘evidence base’ for that apart from Bartlett et al who found appalling levels of ignorance amongst mainstream counsellors responding to requests for reduction in their same-sex attractions.But these therapists wouldn’t have said they were doing “conversion therapy” which is a term largely used by fundamentalist Christians or the Orthodox Jewish organisation Jonah.Conversion therapy IS big business in the USA but here in the UK it’s more that well meaning, under-trained therapists agree to try to help a distressed client manage their same sex attractions by encouraging them towards heterosexuality.This is highly analogous to CAMS and other therapists working with children and families who present with gender non-conforming behaviour brought by their concerned parents worried that their child might be gay or trans and being advised to discourage cross gender play.

I am looking forward to taking up membership of what seems a much more supportive and progressive, albeit smaller counselling body – the National Counselling Society who have a policy of accepting members who are already accredited elsewhere in at the same level as they were.So in addition to my existing membership and Senior Accreditation with the National Council of Psychotherapists (who few people seem to know about), I will become enjoy Senior Accreditation and continue to be on the PSA Register.It was tempting to consider joining one of the more renegade groups of therapists like the Independent Practitioners Network, whom I have enormous respect for, but actually I want to be able to try to influence the profession by being a member of a larger body where we can hopefully raise awareness of equality and difference.

I was very troubled to hear though, how BACP seem to be holding a monopoly on who employers recognise as being THE accrediting/registering body for the profession.One person commented on my post that he didn’t feel he could leave BACP as the NHS (in Wales) wouldn’t recognise membership of any other professional counselling/therapy body.

Another respondent said: I’m a referral counsellor for a therapy centre based on my BACP accreditation, it would mean losing my livelihood unless I could persuade the therapy centre to accept the National Counselling organisation that Dominic mentioned…certainly needs to be thought through before I make any moves as I’m not in a financial position just to leave here not to mention all of the clients I currently see here, many of whom are trans or LGB…

I feel incredibly let down by my professional body – an organisation I have been a member of for almost 35 years and where I am a Senior Accredited Counsellor/Psychotherapist and a Fellow.They have indicated that they are likely NOT to be signing up for a revised Memorandum of Understanding on Conversion Therapy which would be extended to include trans and asexuality.

I am so frustrated by their constant inaction and lack of understanding the issues that I am resigning.Here are some of the reasons why:
As LGB and T people are over represented in the therapy-consuming population, due to demonstrably higher levels of mental distress and self harm there is an obvious and urgent need for counsellors to be able to provide skilled therapeutic support.

This is a rapidly changing field in terms of our knowledge about gender and sexual minority groups, language and concepts are continuously shifting especially with regard to trans issues.

There has been fairly recent legislation affecting LGB and T people’s rights, which therapists are likely to be unaware of.BACP has an obligation to ensure that therapists are to be kept up to date on all this.

Consistently research has demonstrated that LGB and T people have felt poorly served by therapists.As BACP is the largest counselling professional body it’s likely to be the case that there will be a great many members who have not responded appropriately.

In case you’re interested: Cordelia Galgut researched lesbians experiences of therapy, Iggi Moon conducted research into therapists attitudes to bisexuality, Tina Livingstone did a similar study but exploring therapists attitudes to trans people.Karen Pollock researched how comfortable suicidal trans people felt about seeking counselling. Bartlett et al did a large study on the response of mental health professionals to clients seeking help to change sexual orientation ALL found appalling attitudes by counselling professionals to gender, sexual and relationship diverse groups.

The MoU v1 items 18 and 19 make it an obligation that members of the signatory bodies i.e. BACP counsellors should be adequately trained to know how to best respond when someone presents with confusion over their sexual orientation or is seeking a reduction in their same sex attraction or a ‘cure’.

“18 Those with a responsibility for training will work to ensure that trainings prepare therapists to sufficient levels of cultural competence so they can work effectively with LGB clients;

19 Training organisations will refer to the British Psychological Society guidelines on working with gender and sexual minority clients when reviewing their curriculum on equality and diversity issues;”

BACP took two years to resolve a case where someone (an undercover journalist investigating gay cure therapy in Britain) sought the help of a BACP Senior Accredited therapist (Lesley Pilkington) and was offered ‘gay cure’ therapy.One of the major obstructions in the complaints process was to be able to find an unbiased/neutral complaints panel. I think BACP were also very scared that Pilkington was being defended by the Christian Legal Centre. BACP subsequently wrote to all members making it clear members were not to engage in reparative therapy, but have done very little to improve the confidence of therapists to know how best to respond to such requests from clients since then.

“14: For organisations with practitioner members, each will review their statements of ethical practice, and consider the need for the publication of a specific ethical statement concerning conversion therapy”

Today, I was informed in a “courtesy call, as a Fellow of BACP and someone very involved in these issues” that BACP don’t want to create an ever growing “list of orientations and conditions” [my emphasis], when the Ethical Framework already has principles which make unprofessional and incompetent practice unethical.

They want to just rely upon their Ethical Framework (and there is a new one out in July) which is based on ethical principles, currently they are: autonomy, trustworthiness, beneficence, non-maleficence, justice and self respect.http://www.bacp.co.uk/ethical_framework/ethics.php to ensure members act appropriately and ethically.

However, how are therapists supposed to be able to deliver competent and ethical therapy without specific training about gender, sexual and relationship diverse clients?For example, without knowledge of the specific mental health needs and socio-cultural contexts in which minority stress and micro aggressions contribute to much higher rates of depression, suicide and self harm, (with bisexuals and gender variant people having significantly poorer mental health than lesbians and gay men).Research into self harm amongst trans people shows that over 40% of trans people have attempted to take their lives or self harmed, about how relationship dynamics are often different amongst LGB people; about working with gender variant young people.There has been a 400% increase in referrals to the child and adolescent Gender Identity Development Unit at the Tavi and many therapists in community settings are working with young people and their families around gender identity issues.We are increasingly hearing stories from trans people about poor understanding of their issues.Including accounts from gender non-conforming young people being encouraged to follow to gender roles appropriate to the sex they were assigned at birth (i.e. boy’s shouldn’t play with dolls or dress in female clothing etc).

I think BACP are failing to support their members in learning how best to respond to gender, sexual and relationship diverse clients.The occasional article in the Therapy Today does not count as adequate attention to the training and development needs of it’s members.

It’s my view that BACP has become a large bureaucracy which has failed to use it’s power and resources to address the failures of the counselling profession to improve the quality of therapy for gender, sexuality and relationship diverse clients.

The decision as to whether to re-sign for an revised MoU inclusive of Trans and Asexuality has been referred to the Board of Governors who meet in March.It’s been indicated to me that it’s likely they will feel signing up will not be consistent with BACP’s policy and practice.I seriously doubt the Governors of BACP will be a particularly well informed group of individuals who will have their finger on the pulse regarding trans and asexuality issues so this a great way for the Executive of BACP to pass the buck. I’d be curious to see any briefing papers they have prepared for the Board on the issues involved in whether to sign back up to MoU v2.

I was proud to be made a Fellow of BACP back in 2007 for my “distinguished service to the field” but that award has been pretty hollow given how BACP have rarely sought advice and guidance on what they might need to be doing to meet the needs of their membership with regard to helping counsellors improve the mental health of our communities.

My BACP membership is due for renewal next month, but I will not be renewing and I will instead be taking up membership of a smaller but much more responsive professional body – the National Counselling Society who have indicated that they have voted for an inclusive MoU v.2 and that my status of a Senior Accredited member can be transferred to their organisation and that their Professional Standards Committee would welcome my application for a Fellowship.They are also keen to have have my expertise contribute to the way the organisation might support their members.

Perhaps other disaffected members of BACP might want to consider whether they want to continue their membership!

At a time when Lesbian and Gay (LG) equality rights are still being debated by the United Kingdom (UK) Parliament and by several religious organisations, worldwide attitudes towards same-sex relationships remain controversial and ambivalent (Pew Research Centre, 2013). Previous research has identified the existence of such ambivalent attitudes amongst the general population (Herek, 2009; Herek, Gillis & Cogan, 2009), in particular when unconscious (implicit) attitudes are measured and do not always match people’s self-reported (explicit) attitudes (Banse, Seise & Zerbes, 2001; Nosek & Banaji, 2009; Ranganath & Nosek, 2007; Steffens & Jonas, 2010). Equally, attitudes in psychologists seem to follow similar trends (Boysen & Vogel, 2008; Boysen, 2009) where explicit attitudes tend to be positive while implicit attitudes tend to be ambivalent or negative. Such discrepancy between explicit and implicit attitudes can cause internal conflicts in people between their thoughts about, and their behaviour towards, LG people. This can make people come across as ambivalent, distant, and negative (Gawronski & Strack, 2004; 2012) when interacting with LG people.

Research has found evidence that psychologists and psychologists-in-training can show such ambivalence to LG people too (Finkel et al., 2003; O’Brien, 2003; Scher, 2009), including anxiety and avoidance (Gelso et al., 1995), and emotional and social distance (Barrett & McWhirter, 2002; Jones, 2000). Equally, vulnerable clients belonging to minority groups may often be at the centre of unintended discrimination, through ambivalent behaviours, when professionals’ attitudes about clients’ identity are negative or biased. Studies also revealed that psychologists would show less concern for gay clients when their attitudes towards LG people were more negative (Clarke, 2010), consider LG clients riskier and more likely ‘to harm other people’ (Bowers et al., 2005), propose more controlling interventions with gay clients (O’Brien, 2003), be less willing to work with gay clients in therapy (Barrett et al., 2002), regard LG identity as more pathological, and support the use of therapy to change a client’s sexual orientation (Kilgore et al., 2005).

These findings are particularly relevant for clinical psychologists who increasingly may have to see in clinic LG people with psychological and social needs, and to offer them support through direct and indirect clinical work, consultancy and training, supervision and research, and academia-related activities (British Psychological Society, 2006; 2012). Psychologists’ attitudes about clients are then particularly relevant to clinical communication. This is due to the recognition of the potential bio-psycho-social impact that discrimination and prejudice can have on people belonging to minority groups (Meyer, 2003; Davies, 2012). Nonetheless, communication and attitudinal research is a recent emerging phenomena among healthcare professionals (Steffens, 2005; Steffens & Jonas, 2010), remains scarce and is further needed at the centre of clinical psychology practice.

The current research investigated communication patterns on a sample of UK clinical psychologists-in-training toward simulated ‘gay clients’ (professional actors), and how participants’ demographic characteristics and attitudes towards LG people may be related to their behaviour in session with a ‘gay client’ either with depression or with anxiety. The study also looked at changes in clinical communication over time, so each 10-minute ‘session’ was video-recorded to be analysed with two communication measures. ‘Gay clients’ also provided their satisfaction score at the end of each session for each psychologist. Results suggested that the current sample of psychologists-in-training show discrepancy between positive self-reported (explicit) attitudes and slightly negative and ambiguous unconscious (implicit) attitudes towards LG people. The attitudes of the current sample were equivalent to those found in earlier studies (i.e. Boysen et al., 2008; Banse et al., 2001) thus showing a prevalence of unconscious social prejudice and distance towards sexual diversity. These attitudes did not change after six months of clinical training and placement experience.

Furthermore, clinical communication scores revealed that participants interacted professionally with ‘gay clients’ but showed less empathy and interest in client’s concerns and worries. ‘Clients’ also felt overall dissatisfied with their sessions and did not feel a connection with their ‘psychologist’. In particular, psychologists who had more avoidant characteristics had more difficulty in communicating with ‘clients with depression’, did not explore clients’ feelings as often, and gave ‘clients’ less opportunities to speak about their worries. Whenever clients gave hints to the psychologist that they wanted to talk about their concerns, most of the time these were not noted or followed-up by the psychologist. ‘Clients with depression’ felt less satisfied with their session than ‘clients with anxiety’ and findings were similar after six months of clinical training and placement. However, after six months of training, psychologists’ communication scores improved slightly and ‘clients with depression’ felt slightly more satisfied with their session.

These findings are important since previous research has found that practitioners often struggle more when working with clients with depression (e.g. Gonzalez et al., 2013; Annen et al., 2012; Lyons & Janca, 2009). These clients are often perceived as unmotivated and disengaged, and consultations are more difficult to conduct. However, most of the time clients with depression are unsure if they can trust their therapists with their problems and just want to be asked the right questions. When applying such results to LG clients, a study by Newman and colleagues (2010) uncovered that gay men with depression often withheld information about their worries and concerns until they feel that their therapists are trustworthy, ethical, encouraging, knowledgeable, supportive and, most of all, are open and clear. These are important areas to highlight, due to the dual stigmatisation that gay men may face when also diagnosed with a mental illness.

Quality of life, therapeutic outcome and client satisfaction can be greatly improved when there is tailored client participation and decision-making and good clinician communication skills (Vogel, Leonhart & Helmes, 2009). So there is an urgency to ensure that psychologists are trained to provide therapy in a safe and affirmative environment with the right communication skills, even if at first they may feel deskilled to working with LG people. There is also a need for psychologists to revisit their assumptions of sexual orientation through specific sexual diversity training, to prevent cultural and personal bias from transpiring to the therapeutic relationship. In particular, future research could explore the impact of such training on attitudes and clinical communication with gay clients with depression when comparing to heterosexual clients with depression to evaluate if there is any difference in the interaction.